UPDATES ON THE COVID 19 VACCINE DEPLOYMENT AND IMPLEMENTATION

UPDATES ON THE COVID – 19 VACCINE DEPLOYMENT AND IMPLEMENTATION

Maintained by the Disease Prevention and Control Bureau

Office of the Director III for Policy and Planning

(COVID 19 and Vaccine)

Strong

Leadership and Governance

NCA/IATF/NTF/DOH/DILG

Duterte Administration

Vaccine Roadmap

“Command and Control”

2

Whole-of-Government and Whole-of-Nation Approach

Engaged Government Agencies and Private

Sector

Supportive Academic Societies

Medical Experts

Highly Committed LGUs/LCEs

Adequately Informed Communities

Well-prepared Health Systems (HRs,

Funding, Information)

Massive Nationwide Vaccination Program

Tripartite AgreementDistribution and Deployment

Vaccine Administration

Tripartite AgreementPublic Uptake Communication

Supply Chain

Public Uptake Communication

ProcurementSupply Agreement

Implementation

CompliancePublic Uptake

Synchronized and Integrated Efforts

SPECIAL CHAPTER: GOVERNANCE

National Deployment and Vaccination Plan

● Establishment of a national level structure○ A robust system of

leadership, an accountable and transparent decision-making structure and process to protect national interests.

Protect the public and reduce morbidity

and mortality rates due to COVID-19

GOAL

To establish a sustainable immunization program

against COVID-19

MISSION

DOH Vision, Mission, and Goal

Strategic Plan for COVID-19 Vaccination

Safe, equitable, and cost-effective

immunization for all Filipinos by 2023

VISION

1. To provide equitable access to COVID-19 immunization services to priority groupsor at most, 50 to 70 million Filipinos if with enough global supply by 2021.

2. To increase demand for vaccination services through capacity and confidencebuilding measures;

3. To ensure safety in the immunization program and provide support to patientswith adverse reactions; and

4. To institute governance, regulatory, financing and performance accountabilitymeasures for COVID-19 immunization

DOH Objectives

Strategic Plan for COVID-19 Vaccination

● Complemented with

the activation of the

Incident Command

System at all levels

SPECIAL CHAPTER: GOVERNANCE


National Deployment

& Vaccination Plan

CHAPTERSI. Scientific Evaluation and SelectionII. Access and AcquisitionIII. Procurement and Financing ProcessIV. Production, Shipment and Storage

a. Supply Chain b. Cold chain management

V. Distribution and Deployment

a. Vaccination Delivery Strategies

b. Vaccine Deployment Strategies

VI. Implementation of Nationwide Vaccination

a. Masterlisting, Microplanning and Mapping of Vaccination Sites and Teams

b. Human Resource Management and Training

c. Vaccine Administration Policies

d. Infection Prevention and Control (IPC), Injection Safety and Management of Health Care Waste

VII. Assessment, Evaluation and Monitoring

a. Vaccine Safety Monitoring, Management of AEFI and Immunization Safety

b. Safety Surveillance and Response

c. Monitoring and Evaluation Framework, and Reporting Mechanism

VIII.Special Chapters: Governance, Data Management and Risk Communication and Demand Generation

Vaccination Delivery Strategies● Priority populations for COVID-19 vaccinations were identified based on the WHO Strategic Advisory

Group of Experts on Immunization (SAGE) values framework for the allocation and prioritization of

COVID-19 vaccination and reviewed by the National Immunization and Technical Advisory Group.

WHO SAGE Framework

Overarching Goal COVID-19 vaccines must be a global public good. The overarching goal is forCOVID-19 vaccines to contribute significantly to the equitable protection andpromotion of human well-being among all people of the world.

Principles Human Well-Being, Equal Respect, Global Equity, National Equity, Reciprocity,Legitimacy


Chapter V: Distribution & Deployment

✔AEFI monitoring and response● Use of

application for AEFI monitoring

✔Duration: 12 months✔Active and

passive surveillance

✔ Evaluation and Selection of Vaccine

■ FDA Approval (EUA) thru EO of

the President

■ Other considerations

● subjects of Phase III

clinical trials

● mass vaccination

■ Vaccine Expert Panel/Health

Technology Assessment

Council/National Immunization

Technical Advisory Group

recommendations

✔ Simulation Areas (with high burden of disease)

✔ Full roll-out

✔Simulation● geographic● priority eligible

population● sample size● vaccination

sessions strategies

● vaccination processes

✔Duration of campaign: Seven (7) days campaign; if with two doses, at least with 28 days interval per round

Identification vaccine &

eligible population

Identification of Simulation Areas

Masterlisting, Screening and Registration

Vaccine Allocation & Distribution

Vaccine Administration

Post Authorization Surveillance

✔Fixed-post vaccination strategy: RHUs, medical centers, hospitals, infirmaries, private clinics and health facilities of government agencies✔ COMELEC election model with

polling sites/precincts with Task Force (DOH as lead and PNP for security)

PRE-IMPLEMENTATION ACTIVITIES

✔ Requirements: On-the site V/S & PE; informed consent

IMPLEMENTATION ACTIVITIES


Chapter V: Distribution & Deployment

Disclaimer: These plans and its details may change with new developments and scientific

evidence.

Prioritization and

Allocation Framework

Prioritization in the context of scarcityObjectives: (a) reduce mortality and (b) preserve health system capacity

PRESENTED TO CHD ARDs & RESUS ON 2021-02-11

CRITERION 1 PRIORITY GROUPS

Group Priority Sectors

A 1: Workers in Frontline Health Services

2: All Senior Citizens

3: Persons with comorbidities

4: Frontline personnel in essential sectors

inc uniformed personnel

5: Indigent Population

B Other Frontline Workers and Special

Populations

C Remaining Population

CRITERION 2GEOGRAPHIC

LOCATIONCRITERION 3

SUB-PRIORITY

GROUPS

LGU and Supply

Chain

NEED CAPACITY

XEXPOSURE X MORTALITY RISK

For HCWs - by facility directly

providing care, Level 3 DOH

→ LGU → private, other

hospitals, community, stand

alone

For Senior citizenss -

institutionalized, then other

senior citizens

For indigents - in locality with

highest burden, with high

risk comorbidities, etc

Phase 2 - Priority Eligible B

B1 Teachers, Social Workers

B2 Other government workers

B3 Other essential workers

B4 Socio-demographic groups at significantly

higher risk other that senior citizens and poor

population based on the NHTS-PR

B5 Overseas Filipino Workers

B6 Other Remaining workforce

Phase 3 - Priority Eligible C: Rest of the Filipino

population not otherwise included in the above groups

Phase 1 - Priority Eligible A

A1 Frontline workers in health facilities both national

and local, private and government, health professionals and

non-professionals like students in health and allied professions

courses with clinical responsibilities, nursing aides, janitors,

barangay health workers, etc.

A2 Senior citizens aged 60 years old and above.

A3 Adults with comorbidities not otherwise

included in the preceding categories.

A4 Frontline personnel in essential sectors both in

public and private sectors, including uniformed personnel, and those in

working sectors identified by the IATF that are directly client facing and

cannot dutifully meet minimum public health standards.

A5 Poor population based on the National

Household Targeting system for Poverty

Reduction (NHTS-PR) not otherwise included

in the preceding categories.

Sub-prioritization: Priority Group A1

CRITERION 1 PRIORITY GROUPS

Group Priority Sectors

A 1: Workers in Frontline Health Services

2: All Senior Citizens

3: Persons with comorbidities

4: Frontline personnel in essential sectors

inc uniformed personnel

5: Indigent Population

B Other Frontline Workers and Special

Populations

C Remaining Population

Priority A1.1 COVID-19 referral hospitals designated by the DOH;

Priority A1.2Public and private hospitals and infirmaries providing COVID-19 care, as prioritized based on service capability, starting from level 3 hospitals, to level 2 hospitals to level 1 hospitals, and then infirmaries; Among hospitals with a common service capability, the order of priority shall be from facilities owned by the DOH, then facilities owned by LGUs, then facilities owned by private entities;

Priority A1.3Isolation and quarantine facilities such as temporary treatment and monitoring facilities and converted facilities (e.g. hotels, schools, etc) that cater to COVID-19 suspect, probable, and confirmed cases, close contacts, travellers in quarantine;

Priority A1.4 Remaining hospitals including facilities of uniformed services not catering to COVID-19 cases;

Priority A1.5Government owned primary care based facilities such as Urban Health Centers, Rural Health Units and Barangay Health Stations, birthing homes, and Local Health Offices to include members of BHERTS, contact tracers, social workers;

Priority A1.6Stand-alone facilities, clinics and diagnostic centers, and other facilities otherwise not specified (e.g. clinics, dialysis centers, dental clinics, and COVID-19 laboratories), dealing with COVID-19 cases, contacts, and specimens for research purposes, screening and case management coordinated through their respective local government units;

Priority A1.7 Closed institutions and settings such as, but not limited to, nursing homes, orphanages, jails, detention centers, correctional facilities, drug treatment and rehabilitation centers, and Bureau of Corrections.

PRIORITY GROUP A2

Priority

A2.1

Institutionalized senior citizens including those in registered nursing homes

and other group homes with elderly working together

(e.g. convents).

Priority

A2.2

All other senior citizens, including bed-ridden senior

citizens at home

VaccineASTRAZENECA*

SINOVAC

Priority Group A2 Guidelines

MASTERLISTING

Through LGU

● Tap registered and unregistered institutions (group homes, convents)

● OSCA and DSWD registrations● Tapping senior citizen groups and federations● Open calls to general population● House visits for bed ridden senior citizens

IMPLEMENTATION ● Formats and fonts of templates● Rules on authorized legal representative● Adequacy of waiting areas ventilation + MPHS

PRECAUTIONS • Seniors that are bedridden and with poor prognosis need medical clearance

Priority Group A3 Guidelines

Priority Group A3: Adults with Comorbidities

Priority A3

Any non-senior adult between 18-59 years old with any clinically controlled comorbidity

Proofs of comorbidity shall include: ● Medical certificate from an attending physician

issued within the past 18 months● Prescription to medicines for the past 6 months ● Hospital records such as the discharge summary

and medical abstract● Surgical records and pathology reports

Vaccine SINOVAC

SUBPRIORITZATION ● By geographic burden of disease

MASTERLISTING ● LGU of hospital registries● Tap disease support groups, chapters● House visits by community workers● Open call for general population

IMPLEMENTATION ● Cannot be administered to those in active disease (uncontrolled or with symptoms)

PRECAUTIONS ● Those in immunodeficiency need medical clearance after dialogue with physician (Autoimmune

disease, Persons living with HIV, Persons with cancer or malignancy, transplant patients, persons using steroids)

● Controlled comorbidity and active disease to be screened during vaccination day

The vaccine recipient should be screened on the day of the vaccination. They are not in active disease OR they are stable/controlled if they:

1. Have no symptoms2. If vital signs are taken, have stable vital signs

(defer ONLY if hypertensive urgency > 180/90 mmHg)

1. Have had no attacks, admissions, or changes in medication for the past 3 months

2. Currently not hospitalized

VACCINE RECIPIENT - NOT IN ACTIVE DISEASE

Filipinos with the following diseases should be prioritized because they would have higher risk of having severe COVID-19 if infected. Other diseases not stated but fall in the general categories may also belong to Priority Group A3.

1. Chronic respiratory disease and infection such as asthma and respiratory allergies, Chronic Obstructive PulmonaryDisease, Interstitial Lung Diseases, Cystic Fibrosis, or Pulmonary Hypertension, Pulmonary Tuberculosis, Chronic bronchitis,Histoplasmosis, Bronchiectasis

2. Cardiovascular disease such as hypertension coronary heart diseases, cardiomyopathies, peripheral artery disease, aorticdiseases, rheumatic heart disease, congenital heart disease

3. Chronic kidney disease

4. Cerebrovascular disease such as stroke and transient ischemic attack

5. Cancer or malignancy

6. Diabetes Mellitus Type 1 and Type 2

7. Obesity

8. Neurologic disease such as dementia, Alzheimer’s Disease, Parkinson’s Disease, Epilepsy and Seizures, Bell’s palsy,Guillan-Barre Syndrome, or acute spinal cord injury

9. Chronic liver disease such as hepatitis cirrhosis, non-alcoholic fatty liver disease

10. Immunodeficiency state such as genetic immunodeficiencies, secondary or acquired immunodeficiencies (i.e. prolongeduse of corticosteroids), HIV infection, Solid organ or blood transplant patients

11. Other diseases such as sickle cell disease, Thalassemia or Down Syndrome

Who are part of Priority Group A3?

Frequently Asked Questions

WHERE WILL I MASTERLIST?

LGU of your permanent residence, current residence, or workplace

WHERE WILL I BE VACCINATED?

● In LGU-defined vaccination centers linked to appropriate health care provide networks for AEFI management

● Scheduled vaccination may be done on separate days or in:○ HIV treatment hubs, due to confidentiality considerations○ TB centers, esp for MDRTB wherein full vaccination team

will need to wear N95 masks

● At home through house-to-house vaccination, for those bed-ridden who have medical clearance for vaccination

LGUs to enable vaccination by having accessible vaccination sites and/or facilitating transportation of recipients, in compliance to minimum public health standards

On LGU-led Masterlisting and Vaccination

On vaccinating Senior Citizens

WHERE WILL SENIOR CITIZENS GET VACCINATED?

• They can be vaccinated at their assigned LGU sites• Those bed-ridden who have clearance can be vaccinated through

scheduled house-to-house teams or through LGU-facilitated transportation of senior citizens to vaccination centers via shuttles or allowing private transportation.

IS CLEARANCE NEEDED FOR SENIOR CITIZENS?

• Medical clearance is NOT needed prior to vaccination UNLESS they meet conditions needing clearance (Autoimmune disease, HIV, Cancer/ Malignancy, Transplant Patients, Undergoing steroid treatment, Patients with poor prognosis).

• However, they will still be screened for active disease during vaccination day.

WHO NEEDS MEDICAL CLEARANCE?

1. Autoimmune disease2. HIV3. Cancer/ Malignancy, if taking immunosuppressive drugs4. Transplant Patients5. Undergoing steroid treatment6. Patients with poor prognosis or bed-ridden

The objective of medical clearance is to have individual risk-benefit assessment depending onthe state of each patient. This may be done through:● Teleconsultation● Consultation at designated facilities or hubs, if applicable● Through RHU or other primary care centers designated by LGU

DO OTHER CONDITIONS NEED MEDICAL CLEARANCE PRIOR TO VACCINATION?

Other co-morbidities that do not fall under the above subgroups do NOT need medical clearance prior to vaccination.

Screening for active disease shall be done on vaccination day through interview in the health screening form and on-site physician assessment, if necessary.

On Medical Clearance

VACCINATION DAY:

Health Screening and Deferment

DO NOT VACCINATE Age below 18 yo

Severe anaphylactic reaction When to vaccinate?

DEFER

VACCINATION

With symptoms, in active disease Refer to MD

COVID19 case After recovery

Close contact to COVID-19 case After 14d quarantine

Received other vaccine After 14d interval

Pregnant After 1st trimester

Hypertensive emergency 180/120 with signs and

symptoms of organ damage

Bring to ER

*For recipients whose

second dose will be

delayed, give second

dose immediately after

time interval indicated

Updated Health Screening Form and Algorithm as of 12 April 2021

Templates and materials bit.ly/RESBAKUNAMaterials

http://bit.ly/RESBAKUNAMaterials

● Informed consent shall only be taken ONCE, during the first dose. A separate informed consent form for the second dose is not necessary.

● Vaccination sites should ensure compliance to minimum public health standardsEspecially regarding maximum capacity, ventilation, engineering controls such as barriers and sectioning, availability of handwashing stations, wearing of face mask/shield

● Post-vaccination reminders and prompts to confirm presence of AEFI. Minimum frequency: one (1) week, two (2) weeks, one (1) month, three (3) months, six (6) months, twelve (12) months after the date of vaccination. LGUs may have more frequent interval of monitoring depending on their capacity and agreements with the vaccination sites.

Other Vaccination Day Reminders

The need to continuously implement minimum public health standards after vaccination including wearing of face masks and shields, maintaining physical distancing, hand hygiene, seeking consult and immediate quarantine or isolation if exposed or with symptoms, among others.

Second dose schedule and reminders

Mechanisms to report any adverse event after immunization to the vaccination site or the LGU

Initial treatment or management for common adverse events

Contact information or location for consultations or referrals

Post-Vaccination Instructions

PARALLEL ACTIVITIES IN THE VACCINATION SITE?

Parallel activities are allowed in the vaccination site provided that they are: A.) separate from the vaccination and monitoring area, B.) following minimum public health standards,C.) Done after vaccination, and not a pre-requisite to vaccination D.) Does not impact efficient operations of the vaccination program

Possible activities

PHILHEALTH - Membership updating- Registration to primary care provider- To enable financial coverage esp in case of AEFI or healthcare

after vaccination

LGU should coordinate with PhilHealth LHIO

NATIONAL ID/ PHILSYSLGU should coordinate with NEDA/PSA

Determining the Teams and Personnel RequiredOperational Guidelines: Vaccination Teams

● Vaccination Team composition (6)○ (2) Screening and Assessment: Physician/Nurse/Midwife ○ (1) Health educator: Allied Professionals/ Volunteers from partner

agencies (e.g. teachers, social workers, medical students, etc)○ (1) Vaccinator: Nurse/Midwife of RHU ○ (2) Documenter/Recorder and V/S taking: Midwife/BHW/Health

Staff / Volunteers from partner agencies (e.g. teachers, social workers, medical students, etc)

● One (1) supervisor, preferably a physician, for at least three (3) vaccination teams

● Other personnel needed in the implementing unit (fixed point strategy):○ Cold Chain Officers○ Local Officials (barangay captains)○ Security Personnel (PNP)○ Drivers○ Safety Officers (Barangay Tanods, among others)

● Personnel needed in the community/health facility (house-to-house strategy):○ Social mobilizers: BHWs○ Navigators/Transport: BHWS and Local Officials,

Health Facility Management

● AEFI Composite Team composition (2)○ (1) Monitor: Paramedic/Nurse/Midwife○ (1) Surveillance: Surveillance Officer/Nurse/Midwife /Pharmacist

● One (1) vaccination team = One (1) AEFI/AESI composite team

● One (1) vaccination team: 100 vaccinees/day


Chapter VI: Implementation of a Nationwide Vaccination


evidence.




evidence.

● Vaccination Implementing Units

○ Establishments authorized to conduct the vaccination activity

■ Medical centers, hospitals and infirmaries (private and public) i

■ Rural Health Units

■ Health facilities of other government agencies (e.g. AFP hospitals and facilities, 71

BJMP/BuCor health facilities, and DepEd clinics)

■ Private clinics

○ May have several vaccination sites/posts within its vicinity, e.g. a medical center can have

several vaccination sites/posts within its vicinity

● Vaccination sites/posts

○ Areas within the implementing units where the vaccination administration proper is

conducted

○ Interim Guidelines on the Identification and Utilization of COVID-19 Vaccination Sites



evidence.

VACCINATION SITES - composed of vaccination teams, follows MPHS andimplements a logistic system

LVOC - to designate COVID - 19 vaccination sites through compliance with the LGU assessment toolNVOC/RVOC - to designate vaccination sites directly handled by the national government

ASSESSMENT TOOL FOR THE IDENTIFICATION OF COVID - 19 VACCINATION IMPLEMENTING UNITS and VACCINATION SITES● General information● Physical Plant● Personnel● Information management● Equipment/ Instruments

DM No. 2021 - 0116: Interim Guidelines on the Identification and Utilization of COVID-19 Vaccination Sites

Off-site or non-health facility-based sites - linked to a licensed health facility (such as public or private hospital or rural health units); under the supervision and accountability of LGU through the CHOs/MHOs/RHUs

Permanent fixed-post vaccination strategy through the COVID - 19 vaccination units and vaccination sites




evidence.

✔ Scan QR code generated from Pre-registration

✔ Checklist of information

✔Document requirements

✔Health declaration form

✔ Informed consent

✔Utilize checklist before administering vaccination

✔Ensure proper vaccination technique

✔Encode the details in the immunization card and give to the vaccinee

✔Conduct History-taking and Physical Examination ✔Utilize Checklist

and Form

✔Utilize script and checklist✔Counsel patients by

batches✔Answer questions

about vaccine and possible side effects ✔Play Video on COVID-

19 Vaccine

✔Sign final consent form

VaccinationPost-vaccination Monitoring, Surveillance and Recording

COMPOSITE TEAM VACCINATION TEAM

Pre-vaccination Counselling and Final

ConsentRegistration Screening

✔ Observe the patient for 1 hour and watch out for any shortness of breath (SOB), syncope, anaphylactic reaction.

✔Monitor Vital Signs every 15 minutes. ✔ Utilize checklist✔ Respond and give first aid to patients

with AEFI.✔ Refer to hospital if further management

needed.


evidence.

Vaccine Administration Policies

Entrance Exit

RegistrationArea (2)

ScreeningArea (2)

Counselling and Final Consent

Area (1)

Vaccination Area (1)

Post-Vaccination Monitoring Area

(2)

QR and

Data

System

Waiting Area

QR and

Data

System

QR and

Data

System

Projector

or TVBP,

Temp, PE,

Present

Hx

VT1

VT2

VT3

BP,

Temp, PE,

Present

Hx

BP,

Temp, PE,

Present

Hx

Vaccine,

syringe,

SCB

BP, AEFI Kit,

Ambulance

Vaccine,

syringe,

SCB

Vaccine,

syringe,

SCB

S

A

S

A

S

A

S

A

S

A

S

A

S

A

S

A

S

A

S

A

S

A

Entrance ExitVaccination ProperPost - Vaccination

Area

Ave: 15 minutes/person 30 minutes - 1 hour/person

3-5 minutes 5 minutes 3-5 minutes 1-2 minutes SA - Sanitation Area

VT - Vaccination Team


Ideas to Scale up the Vaccination Program


evidence.

1.Tap available support - private sector, military, other NGA

2.Lessen on-site processes by finishing most documents/ screening before

3.Larger vaccination sites for efficiency gains and reduce mass gatherings E.g. gym linked to health facility, engineering controls for minimum health standards

4.Other non-health cadres to perform functions that will reduce HCW administrative workload

5.Better business processes: marketing, organizing, manpower management, ICT tools and platforms,

AEFI Surveillance CycleWorld Health Organization, Guidance for establishing

AEFI surveillance systems AEFIC - Adverse Event

Following

Immunization

Committee

R/NAEFIC -

Regional/National

AEFIC

MOP - Manual of

Operations

ESR - Event-based

Surveillance and

Response

CRF - Case Report

Form

CIF - Case

Investigation Form

National level: national ratesSub-national level: line listing

5. Analysis

RAEFIC and NAEFIC

6. Causality Assessment

Reporting facilities stipulated in AO 2016-0006

1. AEFI Identification

AEFIC Resolutions, official statements

7. Feedback

ESR, CRF, CIFAEFI database

3. Reporting

Advisories, AO 2016-0006, AEFI MOP

4. Investigation

Minor AEFI cases- weeklySerious/ cluster- 24-48 hrs

2. Notification


Chapter VII: Assessment, Evaluation and Monitoring


evidence.

Demand Generation

Communication & Community Engagement

Social Listening

Supply Side Demand Side

Develop and align

messages* & platforms

across public & private sector

Crisis Communication

Opinion-makers &

Influencers

Community Organizers

Activate Communities

Multiply champions

SPECIAL CHAPTER: Risk Communication and Community Engagement


Significant Updates Procurement and Finance

No cost vaccines - COVAX Facility

15%Country's Population

(22 million Filipinos)


148Million

Doses for 2021


50-70Million

Filipinos will be vaccinated in 2021.

Indicative Timeline and Numbers of COVID - 19 Vaccine Arrival

REFERENCES:


● For Demand Generation Playbook: tinyurl.com/DemGenPlaybook

● For standard templates, collaterals and FAQs: bit.ly/RESBAKUNAMaterials

● For LVOCs/LGUs/other local partners or groups bit.ly/COVIDVaccinesPHChampionsKit

● COVID-19 vaccination policies bit.ly/COVIDVaccinePolicies

● Information on COVID-19 vaccines https://doh.gov.ph/vaccines and covid19.gov.ph/vaccine

Maraming Salamat po!

Sama-sama tayo sa

RESBAKUNA: Kasangga ng BIDA

Documents

UPDATES ON THE COVID 19 VACCINE DEPLOYMENT AND IMPLEMENTATION